- A wave of blockbuster drugs are shifting the outlook for type 2 diabetes patients
When it comes to battling life-limiting chronic diseases, there are few genuine moments of hope. But perhaps for the first time, the 4.3 million people living with type 2 diabetes in the UK – and the additional 2.4 million at risk of developing the condition – are facing a very different future.
There was genuine buzz at the annual European Association for the Study of Diabetes in Hamburg earlier this month, where the world’s leading experts in metabolic disease had gathered to hear the latest developments.
And little wonder. There is increasing evidence that a new wave of blockbuster drugs such as semaglutide and tirzepatide – known by their brand names Ozempic and Mounjaro – are creating a seismic shift in the treatment of the disease. The drugs mimic a hormone called GLP-1 which suppresses the appetite (leading to weight loss) and boosts the production of insulin, the hormone that regulates blood sugar, both of which are vital to control type 2 diabetes.
The latest results from trials of tirzepatide – dubbed the ‘King Kong’ of weight-loss drugs – were presented at the meeting, which showed people with obesity who continued taking it for around 18 months lost a staggering 25 per cent of their bodyweight.
Louis J Aronne, from Weill Cornell Medicine in New York, told delegates: ‘It’s really incredible where we are now in the treatment of obesity compared to where we were as recently as five or ten years ago.
‘We’re in the middle of a revolution in the treatment of cardiometabolic disease, with semaglutide and now tirzepatide.’
The epidemic of Type 2 diabetes has already hit 4 million Britons
But this, the conference heard, is only the start. Across the world, scientists are making huge strides in finding innovative ways to not only treat the disease and protect patients from its most serious consequences, but also prevent it.
Here are some of the standout presentations from the conference – and why they matter.
Could men benefit from hormone replacement?
About 40 per cent of men with type 2 diabetes also have low levels of the male sex hormone testosterone, with symptoms which include a low libido, erectile dysfunction, fatigue and memory problems.
And mounting evidence suggests boosting levels with testosterone replacement therapy (TRT) not only improves blood sugar levels but can help men lose weight.
Professor Hugh Jones, from Barnsley Hospital, presented data suggesting that men treated with testosterone gel or injections could see their blood glucose fall by seven per cent after three months and 21 per cent after two years.
‘Some men who have a genetic condition which causes low testosterone are more likely to develop type 2 diabetes,’ said Prof Jones.
‘Low levels of the hormone can cause men to put on weight – particularly around the internal organs – which we also know is directly linked to the condition.
‘Replacing the testosterone seems to counteract this effect. There’s evidence it can improve insulin resistance, cholesterol, obesity and even mortality, while also improving quality of life and sexual function.
‘But most diabetes experts haven’t even heard of the association between testosterone and diabetes.’
One Australian study in 2021 found that men with low testosterone and prediabetes – on the cusp of becoming diabetic – were far less likely to develop full-blown type 2 diabetes when given TRT. ‘It could potentially be used to prevent diabetes,’ said Prof Jones. ‘And in people with type 2 diabetes who are reliant on insulin – the most serious cases – using testosterone has allowed some men to reduce the amount of insulin they need.’
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Giving testosterone to men has previously been controversial due to concerns over the heart risks. But a major US study published in July showed no difference in risk between men given testosterone over 20 months and those given a placebo. Prof Jones said men with type 2 diabetes who are experiencing symptoms of low testosterone should ask GPs for their hormone levels to be tested.
Weight-loss drugs can also help your heart
The big buzz among specialists at the conference was around how drugs such as Ozempic and Mounjaro – and others still in development – may significantly reduce the risk of heart failure, chronic kidney disease and fatty liver disease.
Early results from a major trial of semaglutide (Ozempic), which will be published fully within weeks, suggest that people taking the drug have 20 per cent fewer heart attacks and strokes. It has also been shown to improve the symptoms of people with heart failure.
Scientists are still investigating whether tirzepatide has similar benefits, but a trial looking at its safety in people with cardiovascular disease did see signs it may lead to fewer heart attacks and strokes after a year.
Last week, another trial investigating whether semaglutide could slow the progression of chronic kidney disease in patients with type 2 diabetes, and reduce deaths from kidney or heart disease, was halted early because it worked so well.
Another diabetes drug called survodutide, which works in a similar way, is being investigated in patients with a severe form of non-alcoholic fatty liver disease, caused by a build-up of fat in the liver.
Naveed Sattar, professor of metabolic medicine at the University of Glasgow, said that it was unclear whether it was the drugs or the weight loss which were causing the effects.
‘The smart thinking is that it’s the very rapid weight loss which triggers a cascade of other benefits,’ he said.
‘However, there’s still a debate. The effect of semaglutide on heart failure, for example, may be largely due to the weight loss, but as the drug also interacts directly with the heart and blood vessels, there may be other effects.
‘There’s still a direct effect of these drugs we don’t yet understand.’
Why medication could increase heart risk
People with type 2 diabetes are twice as likely to experience sudden cardiac arrest – when the heart stops beating unexpectedly due to an electrical malfunction.
But research from Amsterdam University suggests that the risk of these events increases by about 66 per cent if someone has a history of taking certain medications, including common antibiotics, psychiatric drugs or prokinetics – which treat symptoms such as nausea and vomiting.
The drugs include anti-sickness drug domperidone, groups of antibiotics such as erythromycin, clarithromycin and ciprofloxacin – used to treat infections – and haloperidol, given to people with schizophrenia and Tourette syndrome.
The researchers, led by cardiovascular expert Peter Harms, said these drugs were known to be associated with a change in the way the heart’s electrical system functions.
Speaking to the conference, Mr Harms urged GPs to be more aware of the associations, particularly in people with type 2 diabetes.
‘GPs will already know that classic cardiovascular risk factors, such as high blood pressure, raise the risk of sudden cardiac arrest in people with type 2 diabetes,’ he said. ‘However, the link with antibiotic, antipsychotic and prokinetic medication is less well known. Our results underline the need for GPs to be aware of the hazards of prescribing these commonly used drugs.’
Get out in the sun to improve sugar levels
Being exposed to sunlight improves metabolism and keeps blood sugar levels within a normal range for longer, according to the results of a study.
Researchers from the Netherlands and Switzerland said that it means people with type 2 diabetes who work in an office environment should get as much daylight as possible by getting outside whenever they can.
The study involved a group of type 2 diabetics who stayed in a research facility where half were exposed to natural light during the day while the other half were only exposed to artificial lighting.
They were all given the same diet and followed the same activity patterns – which means the effect could not simply be put down to exercising outside – and all had their blood sugar levels continuously monitored.
As well as seeing whether the lighting made a difference to their blood sugar, the team also wanted to find out if it affected how well their bodies switched from using carbohydrate as an energy source in the day to using fat at night.
This should be a natural process, as the pituitary gland in the brain releases a growth hormone which encourages the body to use stored fat overnight to power its repair processes.
But researcher Ivo Habets, from Maastricht University, explained: ‘We’d previously shown that people at higher risk of type 2 diabetes are less able to make this switch. We wanted to find out if exposure to natural light would make this switch over easier in people who already have diabetes.’
They found that when participants were exposed to natural light their blood glucose stayed within a normal range for longer (59 per cent of the time) compared with those using artificial lighting (51 per cent of the time).
They were also able to calculate that natural light made it easier to switch to fat as an energy source at night.
Mr Habets said: ‘If you work in an office with almost no exposure to natural light, it will have an impact on your metabolism and your risk or control of type 2 diabetes, so try to get as much daylight as possible and, ideally, get outdoors when you can.
‘Further research is still needed to determine the extent to which artificial light affects metabolism and the amount of time that needs be spent in natural light or outdoors to compensate for this.’